More Than 100 House Democrats Endorse Medicare for All Plan That Would Eliminate Private Health Insurance in Just Two Years

A new single-payer plan would be even more disruptive and expensive than Bernie Sanders' proposal.

Over the last two years, Americans have become increasingly open to the idea of Medicare for All, partly as a result of single-payer proposals like the one put forth by Sen. Bernie Sanders (I-Vt.).

This, in turn, has led much of the Democratic Party's 2020 field to embrace the label. Yet Medicare for All's rise has coincided with a dilution of the phrase's meaning. To some, it still means strict single-payer, with all of the costs and disruption that entails; to others, it merely means some expansion of government involvement in health care, perhaps using today's Medicare program for seniors as a foundation.

The fuzziness of the label's meaning has clearly helped aid its rise: Polls consistently show that Medicare for All is popular only until people are told what it would entail in its single-payer form—higher taxes and a massive increase in government spending, the end of Medicare as we know it today, and the swift elimination of current private health insurance, which covers nearly 180 million Americans. Even simply calling the idea of a government-run health plan "single-payer" significantly reduces public support.

This reality of public opinion explains, for example, why Sen. Kamala Harris (D-Ca.) softened her position on single-payer after saying she would eliminate private health insurance, and why Sen. Amy Klobuchar (D-Minn.) has taken to describing it as "aspirational." Medicare for All has found success as an ambiguous slogan, but not as a specific policy, because the specific policy it is most associated with—government-run single-payer health insurance—is broadly unpopular.

Today, a group of more than 100 House Democrats, led by Rep. Pramila Jayapal (D-Wash.), are introducing new Medicare for All legislation. The intent of the release, supporters of the plan say, is to clarify what, exactly, Medicare for All refers to. And what it apparently refers to is a plan that includes, and expands upon, all of the most disruptive and least popular elements of single-payer.

Among other things, the Jayapal bill would eliminate existing private health coverage arrangements in just two years—even faster than the four-year timeline called for in the Sanders plan. Some private supplementary coverage might exist after the transition, but the market for private coverage as we know it would end. Indeed, Jayapal has foregrounded the plan's disruption of existing coverage: "We mean a complete transformation of our health care system and we mean a system where there are no private insurance companies that provide these core benefits," she told reporters yesterday.

The transformation she describes would extend to Medicare itself. Although the plan is labeled Medicare for all, it would not simply extend Medicare in its current form to all Americans. Instead, as The New York Timesreports, it would "drastically reshape Medicare itself." Medicare, which faces a trust-fund shortfall in the next decade and is among the biggest drivers of the long-term federal debt, is certainly in need of significant reforms, but polling shows that Medicare for All becomes unpopular if it is understood as a threat to Medicare as it exists now.

The most significant way that the new plan would change Medicare is by overhauling how it pays hospitals, moving from individual service-based payments to global budgeting, which caps total spending and then allocates amongst providers accordingly. These reforms would be certain to spark intense opposition from the health care industry, which would argue that a federally-imposed cap on payments would lead to longer waits to see doctors, delays in treatment, and other forms of rationing. In a recent poll by the Kaiser Family Foundation, the single most effective criticism of Medicare for All was that it would lead to delays in medical tests and treatments. Although that poll found that 56 percent of respondents supported a plan in which all Americans get insurance from the government (essentially single-payer), support dropped to 26 percent when treatment delays were raised as a consequence.

Not only is Jayapal's plan more disruptive than predecessors, it is probably more expensive, providing for additional long-term care services not part of today's Medicare system or the Sanders Medicare for All bill.

Like previous single-payer plans, however, Jayapal's bill does not explain how the new system would be financed. Multiple estimates have put the federal price tag for the Sanders plan at around $32 trillion over a decade, even under generous assumptions about the ability and willingness of the health care industry to absorb significant payment reductions.

Jayapal has positioned her bill as a corrective to anyone who might think that Medicare for All means anything other than a strict single-payer plan. "I think this 'Medicare for All' bill really makes it clear what we mean by 'Medicare for All,'" she said yesterday in advance of the plan's announcement. In that sense, at least, the new bill is a success. What she and the other Democrats who have signed onto the legislation have clarified is that they support a plan that is even more disruptive, more expensive, and probably less popular than prior single-payer plans.

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216 responses to “More Than 100 House Democrats Endorse Medicare for All Plan That Would Eliminate Private Health Insurance in Just Two Years”

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I increasingly believe this is the platform many Democrats are running:

Everybody all the same Burn it down and start again Society will never ever change Pull down empires, kill the kings Give us back our dignity Burn it down and start over again Burn it down and start over again

Oh, they steal from the poor too, using minimum wage laws. The inflation it induces [being across all states] reduces buying power, which we see at the grocery store first on account of high turnover of items. That, and tax brackets never track 100% in parallel, pressing people into paying more. When a $1 raise gets you an increase in the cost of living of say… $1.04, you’ve been screwed. Then there’s the ripple effect: raises that can’t be asked for, and positions eliminated. Dems are leading us right down the path of bread and circus.

Sure you could have. The president’s party losing seats in the mid-terms is an easy guess. So if you were trying to spin that positively, saying it would lead to a bigger wave the next time the super-popular president was on the ticket would have been easy.

The problem is, you refused to consider any scenario where Republicans lost seats in the mid-terms.

So it’s not that you couldn’t have predicted, it’s that you didn’t want to.

Seriously, when your support requires obvious delusion, that’s when you go from being a fan to a fanatic.

Any number of pundits were on TV crowing about the overthrow of the racist Trump-istas in the House as a “truly historic” Blue Wave.

Not.

After spending hundreds of millions of dollars (outspending GOP by 2-1 by some reports), with huge chunks backed by billionaires like Tom Steyer and Michael Bloomberg, Democrats did indeed retake the House.

Before the election, Congress was 51-47-2 in the Senate (GOP-Dem-Ind) and 235-193-7 (GOP-Dem-Vacant) in the House. After, is 53-44-2 in the Senate and 199-235 in the House. Republicans lost 41 seats in the House and gained 2 seats in the Senate.

Compare to 1994. Before the election, Democrats had 56-44 majority in the Senate and 258-176-1 majority in the House. After that election, Republicans had a 52-48 majority in the Senate and a 230-204-1 majority in the House. That was in Bill Clinton’s first term. Democrats lost 54 seats in the House and 8 in the Senate.

In Obama’s first term, before the 2010 elections, Democrats had a 57-41-2 majority in the Senate and a 257-178 majority in the House. After the elections, they had a slim 51-47-2 majority in the Senate and a 193-242 deficit in the House. Democrats lost 63 seats in the House and 5 in the Senate. They would go on to lose the Senate majority, too, in 2014.

Current house leadership suggests you are wrong about congress. They are clinging desperately to maintaining zero philosophy of governance: only the free lunches coughed up by lobbyists matter. I’m guessing… house loses another 8 seats to the modern day marxists, but the senate picks up 2 seats for the party of the stupid – IF they triple the pace of confirmations. A 14 year schedule is no government at all [good or bad].

That made me think of something else, at least for doctors. In the U.S. four years in a bachelor’s program and then another four years in medical school amount to eight years. In countries like Germany, medical programs are only six years long beginning after high school.

Revamping licensing and requirements for doctors to allow for six-year programs would help reduce costs.

Well, if we are limiting discussion to things ‘realistic’ you can forget getting rid of the FDA. FDA approval of a New Drug Application being the worldwide gold standard for selling your drug product. Nobody with an patented NDA or pending NDA approval is going to give that up without a fight.

I saw no mention of “getting rid of the FDA.” I took the Eric Bana’s comment to refer to the duplication of approvals involved in the FDA requiring trials for drugs that have already been approved by the agencies he mentioned.

No, it isn’t liberopia but it is a politically achievable goal which could very well achieve its stated goal; ie getting drugs to market faster and at lower prices.

Except there is no duplication. The FDA does not “require trials” for drugs already approved by other agencies. If the trials used to obtain other approvals are sufficient for FDA approval then they may be submitted as part of the NDA.

If those trials are not sufficient for FDA then what you are describing is an alternate lower standard for approval. Accept lower standards and you are effectively advocating for the elimination of the FDA.

In case I was not clear. The FDA does not require that you do the same work twice. Do it right and once is sufficient. The issue with the FDA is that they generally require you do more work, and to a higher standard.

But… you can often get medicines in places like France a good 5 years before the FDA can find their ass with both hands. Something is wrong, although maybe you are objecting to a half measure? Studies do get swept aside/ignored, and burdens get placed on the US market that nobody else has. When devices as simple as let’s say a toothpick cost 20x more than if they were used for veterinary purposes, we have a problem… and it’s government. A wrist brace for bowling is fifteen bucks, but a similar device issued by a doctor being $300 is killing disposable income, and threatens our economy.

” you can often get medicines in places like France a good 5 years before the FDA can find their ass with both hands.”

I hear this, and would like to believe it. Can you name any specific drugs or drug products that were first available in France (or anywhere in Europe really) prior to FDA approval? Again, not that I do not think they are out there, I would like to know what they are and what they treat.

And the reality is that the FDA approval costs the same, takes about the same amount of time, and has slightly looser standards on some stuff (mainly ‘orphan drugs’ definition and ability to keep data proprietary if it hasn’t been published) than those. Any blockbuster-type drug (big market in both places) is going to go through all those approvals at the same time in order to get to market first. A smaller market or different sales process in different places may lead to a decision to get approvals sequentially – but those are – smaller markets and less relevant.

The biggest issue re pharms in the US is the lack of GENERICS. And even then – let me repeat – 10% of total healthcare spending.

The reason they don’t understand what health care costs is because employers pick up 80% or so of the cost – a bit more for the higher-paid and a bit less for the lower-paid. And the reason employers are involved in that is because they get a tax deduction for it.

And most hospitals now have online price lists. So the whole ‘transparency’ thing is now ‘solved’. It doesn’t do a damn thing and never will – cuz no patient has the knowledge to know how to ‘manage’ those costs except to pretend to bargain like its all some Middle Eastern bazaar. Heart surgery for $90,000? The guy down the road just offered $84,700 – why should I buy here? Seventeen #3 sutures? I only think twelve #4 sutures were necessary so that’s all I’m paying for.

Negotiating best costs for acute and emergent care is surely an issue. But a HUGE portion of medical spending is neither acute nor emergent. If my GP tells me I should thinking about getting knee replacement surgery in the next year or so, for example, I should be able to shop around for a good price from a good surgeon.

Any number of chronic conditions like diabetes, asthma, COPD, Chron’s, high blood pressure, history of stroke (blood thinners), high cholesterol (statins)… Not to mention trauma which is often left untreated for months or at least defers surgery pending a PT attempt, like ACL, rotator cuff, labrum, etc. These are all conditions for which a value maximization should take place (where value is lowest price with best outcome).

We rely on insurance companies to regulate the cost. They have contracts with hospitals as to what they’ll pay for a given procedure. The average person simply can’t know enough to know what’s a “fair” price or not.

The average person simply can’t know enough to know what’s a “fair” price or not.

Price transparency provides that. At least the car stealership lets you know how much they’re going to fuck you over before they turn a single bolt on the car. With hospitals, you don’t find that out until after the service has been performed.

Ever heard of the “reasonable and customary spiral”? A charge is considered reasonable, usual and customary if it matches the general prevailing cost of that service within your geographic area, which is calculated by your insurance company.

How do they calculate that? They survey providers. So let’s say that this year they find that providers are charging an average of $1000 for procedure X. Obviously some providers charge less and some charge more, since that’s an average. Insurance company will negotiate based on the $1000 (or a somewhat lower amount).

What tends to happen next? The lower-cost providers can “safely” increase their charges to the new R&C amount. The higher-cost providers, well, they just keep re-billing their patients for the difference.

Now, the next time R&C is surveyed, to no surprise, the average cost has gone up. At least partly due to R&C levels raising the price that lower-cost providers might have charged.

Most of these sound reasonable, but the medical industry is going to be heavily opposed to them all as it loosens their control over the industry by opening it up to competition.

Which is another reason we might actually get real socialized medicine: when the industry opposed all the small, reasonable measures, without actually fixing any of it’s own problems, folks start to agitate for more and more extreme measures.

Look, the Democrats might be flirting with ideas that conflict with the Koch / Reason libertarian commitment to fiscal responsibility. But the Republicans are literally pawns of a hostile foreign power. I’ll gladly accept Medicare for All (and the Green New Deal) as long as it’s passed by patriotic, pro-American legislators.

The reality is that if medical billing keeps getting increasingly obtuse and obfuscated, that if people keep getting surprise bills for absurd amounts for very little care done, and in general, medical billing continues to expose itself as a malicious entity, then we’re going to get socialized medicine.

Because right now, every step between the actual service you receive and your checkbook is full of bad actors who are manipulating the process to make it impossible to make rational informed decisions. And that is what’s going to make people chuck the whole system into the dumpster and try something new.

Even folks who are ostensibly sympathetic to the libertarian cause in the general are weighing the pros and cons of strong 2nd Amendment protections vs. health care protections. Apparently going bankrupt after being treated for a heart attack is seen as a market failure in their eyes. Who knew?

And the libertarian clarion call of “kill then all and let the market sort them out” isn’t doing them any favors in trying to sell libertarians ideas to the broader public, even if the economic arguments are on their side.

The specter of Obamacare should have been the wake-up call to the health industry to innovate like a motherfucker to reduce costs and avoid government fucking up their shit even more. And they failed. Miserably.

And now the very real possibility of nationalized healthcare is on the horizon, mostly born from free-markerters’ indifference and “let charity take care of it” not being a workable policy.

And the libertarian clarion call of “kill then all and let the market sort them out”

That strawman you lit on fire was so large, NASA’s satellites picked up the heat signature.

There’s suggestions in Eric Bana’s post above that you conspicuously ignored. Another poster last week offered similar proposals, particularly in increasing the supply of medical schools and medical practitioners, and the response of Arthur L. Hicklib was that “no one was offering a plan.” I’ve mentioned plenty of times on these pages that price transparency needs to be implemented, and price fixing prosecuted.

This is why left-wing arguments regarding healthcare can’t be taken in good faith–because even sensible proposals are dismissed with the same stupid strawman you burned to the ground.

As I responded above, the problem with most “sensible proposals” is that they are often heavily opposed by industry, leading to the stagnation and terrible status quo, year after year, that we have.

Eventually, politicians (pushed by their constituents) are going to grow a spine and do something. But the longer it drags out, the more likely that “something” is going to be something big (like Medicare for all) then something “sensible” (like allowing drug imports from Canada).

Tell me again how people here who identify themselves as libertarians don’t regularly make comments like supporting the right of people to die in the street. Tell me again how libertarians support caveat emptor to the degree of opposing even mild regulation as creeping socialism, trusting Yelp reviews and tort from beyond the grave to sort out bad actors. Tell me you can’t grasp how a bit of hyperbole might be in order to showcase the fucking hell of the worst of libertarianism.

And while you’re at it, maybe you can explain how you intend to increase the number of medical schools and medical practitioners that isn’t already operational in market forces? Do you do it through gun point? Regulation? Tax incentives? Encouraging emigration from abroad? How is this to be accomplished beyond unicorn farts and best wishes?

How do you force price transparency without government force? Shouldn’t competition within the market already made this de rigueur? Why are you interfering with the markets? Are you some kind of communist?

And onward and onward. Libertarians are their own worst enemies and incapable of admitting their own shortcomings., which is EXACTLY why we will get socialized healthcare.

Tell me again how people here who identify themselves as libertarians don’t regularly make comments like supporting the right of people to die in the street.

You’re a psychotic and you should seek help before you pull a Jussie Smollett.

The rest of your stupid rant is just a play on “libertarians are anarchists!” pap that shouldn’t be taken seriously. Every single proposal that I listed has a more realistic means of being accomplished than the fanfiction known as the Green Leap Forward.

Now fuck off back to your campus coffeehouse, you leftist cancer cell.

Notice how the Great Leap Forward is actually being discussed and voted upon by people with more authority than idiots on a message board as an upgrade from Obamacare, while your wise proclamations of how you’d personally solve something as wicked complex as healthcare costs amounts to less than two farts and a giggle?

Notice how pricing requirements have already been implemented, but your wise braintrust is completely ignorant of the fact, among other things? I certainly have faith you know what you are talking about.

Notice how no one here is actually advocating for the Green Leap Forward, but merely detailing the lay of the land as to why we think it will happen, and you are a bit too full of yourself to grasp this fact?

Don’t you hate it when reality bitch slaps you so hard, your only retort is “leftist”?

Unlike you, I actual believe in markets, and not just convenient, self-serving brand of “libertarianism”.

“Every student wishing to practice medicine must pass the United States Medical License Examination, and all states impose additional requirements from state licensing boards. These are frequently lengthy and expensive procedures. Medical organizations such as the AMA have an incentive to limit the number of licensed doctors practicing in the marketplace, in order to protect high wages for established incumbents.”

The question isn’t freedom of association or not, its crony capitalism or not. State licensing boards are composed of members of the AMA and controlled by the AMA.

“The fact that these medical boards are private rather than public entities is supposed to make us feel more free, but in fact, most members of these boards are appointed by state governors. When state laws forbid competition among regulators, and signal that the government will regard as binding anything the medical board decides to do, the distinction between public and private becomes meaningless.

For example, the California Business and Professions Code (Section 2220.5) states that “The Medical Board of California is the only licensing board that is authorized to investigate or commence disciplinary actions relating to physicians or surgeons” and charges the board with investigating any and all complaints from the public, other doctors, or health care facilities, or from the board itself. Although the board is technically private, the government sanctioned monopoly on enforcement stands as a barrier to entrants of the medical profession, who are forced to comply with a monolithic set of “take ’em or leave ’em rules,” with which they have no choice but to comply, or risk being barred from practicing their trade.” -from above Mises article

“A Federal district judge ruled that the AMA had violated the Sherman Antitrust Act in 1987 by depriving chiropractors access to the Association. The lawsuit, filed by four chiropractors, accused AMA of conspiring to prevent chiropractors from practicing in the United States.[47]”

“The AMA has one of the largest political lobbying budgets of any organization in the United States. Its political positions throughout its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the health maintenance organizations established during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the US Supreme Court.[65]”

“Nobel Memorial Prize-winning economist Milton Friedman as well as his wife, Rose Friedman, have claimed that the organization acts as a guild and has attempted to increase physicians’ wages and fees by influencing limitations on the supply of physicians and competition from non-physicians. In the book Free to Choose, the Friedmans stated that “the AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible.”[72] Profession and Monopoly also criticized the AMA for limiting the supply of physicians and inflating the cost of medical care in the U.S as well as its influence on hospital regulation.[73

In a 1987 antitrust court case, a federal district judge called the AMA’s behavior toward chiropractors “systematic, long-term wrongdoing”. The AMA was accused of limiting the associations between physicians and chiropractors. In the 1960s and 1970s, the association’s Committee on Quackery was said to have targeted the chiropractic profession, and for many years the AMA held that it was unethical for physicians to refer patients to chiropractors or to receive referrals from chiropractors.[74]”

I would not call Medicare “socialist”. The means of production (the providers) are still generally private parties. Medicare is more fascist. Social Security is not socialist. It’s simple wealth transfer, though some would argue it’s not even that. The V.A. is socialist.

The problem is too many people can’t afford health insurance. The Democrats’ solution to this is to eliminate the means that the vast majority of the country uses for paying for their health insurance. Yeah, that makes sense. It makes almost as much sense as deciding that the solution to healthcare being too expensive was to make everyone buy insurance.

The same people who not ten years ago passed a law forcing everyone to buy health insurance are today pledging to make health insurance illegal. These people are lunatics.

“More Than 100 House Democrats Endorse Medicare for All Plan That Would Eliminate Private Health Insurance in Just Two Years”

There’s an excellent argument to make that keeping a Republican in the White House is extremely important from a libertarian perspective.

Add this to the Green New Deal.

I know from recent news stories that people with MAGA hats like to beat up TV stars for being black and gay, and, what’s worse, if we get another Republican nominating judges, it won’t be long before people in Alabama may have no choice but to take birth control as a serious responsibility before they have sex. No, I don’t know how transgender kids in North Carolina will ever figure out which bathroom to use if we get another Republican in the White House after Trump, and that is an extremely vital issue that affects us all in some way . . .

That having been said, when the Democrats become overtly about authoritarian socialism, this libertarian capitalist will be pulled towards supporting the Republican party.

No private health insurance and growing support for the Green New Deal, too? The Democrats might be wise to disarm the American people first.

Your article cites $263b spent on immigration enforcement, which it divides largely into interior controls and border security, since 1986.

$263b/33y = $11.4b/y

A quick glance at costs of illegal immigration shows estimates from $1.1b/y to over $100b/y (one estimate was $300b/y, but we’ll dismiss it as an outlier, even though we’ll be generous and not dismiss the low end as also an outlier). So we’ll split the difference, again being generous to the low end 100b-1b=99b/2=49.5b

We’ll continue our generosity and add Trump’s proposed $5.7b for the wall as a yearly cost, despite it’s clearly intended function to reduce the need for such funding, to the above immigration control number you cited. 11.4b+5.7b = 17.1b

So we have $17.1b/y for immigration enforcement (a number likely reduced by a permanent structure that reduces illegal entry thus also reduces cost of interior enforcement), vs $49.5b/y cost of illegal immigration.

Your big government overlords thank you for your support for their bloated paychecks and continued rule over your life.

You won’t get to libertopia by supporting more and more government over your life. Oh wait – you don’t want libertopia!

A quick glance at costs of illegal immigration shows estimates from $1.1b/y to over $100b/y

You do realize that most of these estimates include the cost of enforcement itself in “the cost of illegal immigration”? So let’s reduce those costs by cutting spending on enforcement. That way, the illegal immigrants stop costing us all so much money! They can stop leeching off the public dole by costing us so much when the state throws them into cages!

“”Among other things, the Jayapal bill would eliminate existing private health coverage arrangements in just two years””

This is real socialism. Not because it is a way to cover people’s health care via taxes, but because it creates a government monopoly for healthcare. Even counties with socialized medicine allow private coverage.

Yes. One thing that would be certain is that you would no longer be able to sue your doctor if he screws up because you would be suing the government and they could not allow that. Of course, Any settlement would be getting paid with tax dollars anyway, so our elected oligarchy probably would care.

We know RRWP. When you say “keep out the socialists” what you really mean is “keep out the brown people, whether they are actually socialists or not”. Hot white supermodels from formerly socialist countries can walk right in even if their politics make Bernie Sanders look like a Republican.

God bless these 100 democrats that voted to have medicare for all. Medicare for all will not only bankrupt America, but it will also ensure all the little people get in line with the correct socialist doctrine of enslavement of the masses as Lenin stated. Medicare for all is enslavement for all. Aren’t the socialists in the Politburo of the United States wonderful?

“Nor is there any reason why the state should not assist individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. There are many points of detail where those wishing to preserve the competitive system and those wishing to supersede it by something different will disagree on the details of such schemes; and it is possible under the name of social insurance to introduce measures which tend to make competition more or less ineffective. But there is no incompatibility in principle between the state providing greater security in this way and the preservation of individual freedom.”

Life – the payment is FIXED. And life insurers have all sorts of rules about not covering suicide to prevent paying anything in that event. That’s a very predictable and limited risk for the insurer.

Liability – You are paying to protect OTHER people from your actions. Not to receive payments that benefit you.

Auto – Again most of the cost is protecting OTHER people from your actions. And to the limited degree that you are paying for repairs to your car (not required coverage in any state), they have all sorts of rules to ensure that is FIXED. Capped at the replacement value of your car – and you can’t suddenly say you’ve got a Porsche when you’ve been paying premiums for a used shitbox.

‘Health insurance’ is a purely private market is nothing but cherry-picking the risk pool and trying to dump the expenses on someone else.

One thing we might do is have thousands of insurance “pools” base on a applying some algorithm to a person’s social security number to randomize things a bit. Catastrophic insurance from birth. Each “pool” would be managed by an agent who would be responsible for contracting with some insurance company. The members of the pool would never change except when members die off and new members are born. Of course, “the devil’s in the details” as some would say.

Problem is insurance doesn’t actually DO anything in medical. It’s just a way of figuring out who pays the bills – not who fixes you. For other insurance, the bill paying IS the only thing the insurer is expected to do. For medical, the ‘who fixes me’ is the only important issue.

And medical care provision is a VERY local thang. Tertiary care (like Mayo) may be ‘national’ – but that always starts as local case-management.

Unless there is some mechanism for eliminating fraud and waste, insurance is just additional overhead to healthcare costs. Really no different than a nationalized plan in the fact there is an intermediary between the purchaser and the supplier. Any argument you could make about market distortions would apply in either case, so I am puzzled that private insurance is seen as a cost saving measure.

Police are not forced. It is voluntary. They can work security for a private firm. Firemen are not forced. It is voluntary. There are private firefighting companies they can work for. Paramedics are not forced. It is voluntary. There are private ambulance companies they can work for.

Under medicare for all, what choice does a doctor have if they don’t want to do business with the government? They don’t get to volunteer. There is no choice. What if too many doctors leave the profession? Force.

There is no single payer federal fire department or police department, unless you count the unaccountable CIA, FBI,TSA, etc. And would you really prefer to have your local police run from the federal level where it would be even more impossible for you to exercise any oversight via local or state government?

My dad did. Facing pancreatic cancer and a prognosis of something like 2-5% of getting 6-12 months more life after expensive, invasive, painful and most-likely futile chemo, he chose instead to live as best as he could without treatment until the end, which was only 2.5 months, and then only palliative care in his home. And he had GOOD insurance.

I respected his decision then and now especially considering how much of US healthcare dollars are spent in massively expensive end-of-life treatment to buy grandma or grandpa one more week on ventilators in ICU. Families don’t care because Medicare covers it all right? “Just do something!”

Blah blah blah. What is your plan for ensuring that every citizen has heath care and/or health care insurance that is realistically affordable? Just keep kicking the can down the road is not fucking feasible anymore. Ask around. Talk to the self employed and those who do not have employment based insurance. It is a nationwide crisis.

I’ve worked for myself my entire life. For 20 years, prior to Obummercare, I paid a small monthly premium for a perfectly good catastrophic health insurance policy and everything else out of pocket. Perfectly affordable.

The problem is that we view health care as a right, rather than a cost of living like housing, groceries, and utilities. So it’s not something we believe we need to budget for. Instead, we’ve allowed gov’t to interfere to such an extent that prices skyrocket and then whine, “But, but, but, how am I supposed to budget for THAT?”

For 20 years, prior to Obummercare, I paid a small monthly premium for a perfectly good catastrophic health insurance policy and everything else out of pocket. Perfectly affordable.

Did you ever actually have a catastrophe? Cuz the only way to actually judge a catastrophic plan is AFTER that happens. It’s pretty easy to come up with a cheap plan – that denies payment and turns into a nightmare when a problem happens – and then at year-end says, ooh looks like you’re not healthy anymore so we’re not going to reup you so you are now 100% responsible for the catastrophic. So sorry. Oh and thanks for the 20 years of premiums.

It’s not imaginary. Every year, 2-5% of people in the individual market were denied coverage renewal for ‘pre-existing conditions’ – ie they incurred some catastrophe in that year and so by Nov/Dec (or when the policy year renewed) of that year they were deemed to have a pre-existing condition. That 5% of the population also accords with the distribution of medical spending – where 5% of people account for 50% of total spending (and for the under-65’s, that is even more concentrated).

So those companies were able to reduce their cost risk (and the premiums) by 50% by simply screwing those who incurred catastrophic expenses. Doesn’t mean they didn’t pay anything – but it most certainly meant they cut people off the moment they could. And you can bet their lawyers know how to write an insurance policy so that you can’t possibly actually understand exactly how it works in the event of catastrophe.

Every year MILLIONS of people die. From all kinds of causes, not just denial by their insurers. There is no way to guarantee that every single person on this earth is saved from inconvenience, tragedy, and horror. It’s like trying to count to infinity. Progressives think they can do it, though, and that faulty thinking leads them to commit crimes against individual liberties?the welfare of humanity is always the alibi of tyrants. As much as I also side-eye conservatives these days, at least they are willing to admit the reality that sometimes life just sucks. But if your solution is to hold an entire population hostage to gov’t control, count me out. Fuck it. I get cancer, I’ll go sit on a flat rock somewhere and enjoy the scenery until I die.

To what end? Seriously, get a life, Tony. Many of the people I know were self-employed pre-Obummercare and were perfectly able to afford health insurance. Just because you aren’t able to support yourself, doesn’t mean other people aren’t.

Simple. Assuming that we as a nation have a responsibility to “ensure that every citizen has health care and/or health insurance that is realistically affordable” (whatever that means), all we need to do is create a government fund that covers the shortfalls. And then eliminate all the regulations promulgated under the ACA. It would be far more easily managed and far less expensive.

What is your plan for ensuring that every citizen has heath care and/or health care insurance that is realistically affordable?

Fuck off. You don’t give a shit about the cost–if you did, you’d realize that the costs for Medicare and Medicaid Services have risen from around $850 billion in 2008 to $1.4 trillion today.

What is YOUR plan for ensuring that the real, actual cost of healthcare actually goes down, not just “everyone has to get health insurance!”? Because even countries with “government healthcare” end up allowing supplemental private insurance plans–even Jayapal’s home country of India. Otherwise, they’d be entirely reliant on the shitty government system.

At this point, the entire medical / healthcare industry looks like a cartel. Yep, we will end up with socialized medicine (not a good thing) due to the the republican failure on repeal and replace. Although the unions and gov’t employees platinum plans could vote no. A federal government catastrophic plan or re-insurance that hits at a percentage of AGI for U.S. citizens only, would have been perfect while private insurance fills that gap.

At this point, the entire medical / healthcare industry looks like a cartel. Yep, we will end up with socialized medicine (not a good thing) due to the the republican failure on repeal and replace. Although the unions and gov’t employees platinum plans could vote no. A federal government catastrophic plan or re-insurance that hits at a percentage of AGI for U.S. citizens only, would have been perfect while private insurance fills that gap.

The obsession with healthcare betrays a profoundly weak mentality. We sound like a nation of the sick and feeble Who demand that we be cared for. It might be the most unAmerican position one could hold.

Tony’s comment, below, exemplifies that mentality. Progs will tell you they care about the poor and indigent, but they are really scared shitless of life as a whole and want cradle to grave assurances that nothing bad is ever going to happen?to themselves. They can’t face the reality that life is short, and many people will spend it miserably, regardless of what gov’t programs are in place to ensure otherwise. So they bitch and moan instead of getting on with things and taking responsibility for themselves.

So stop looting me to pay for cops and courts to protect your property rights. Crybaby.

Speaking of babies, are they meant to be rough and rugged and take care of their own basic needs, even in the absence of good parenting, or are they to be left to Darwinian processes too? Doesn’t the existence of children, even ignoring everything else, complicate your idiotic scheme?

Tony, people here have been over and over this. But, again: Stop conflating socialism/socialized services with the very few things gov’t is tasked to do under our Constitution to protect our civil liberties. Also, cops and judges and firefighters volunteer their services. They aren’t forced into conscripted service.

The constitution is neither libertarian nor ruggedly individualist. Make an actual argument. Clearly the constitution does permit a lot of programs you don’t like; otherwise they wouldn’t exist. Of course you can change that by filling the courts with people who agree with you.

They WILLINGLY choose to work as judges, public defenders, cops, firefighters, you dimwit. But, yes, in some instances, they do “volunteer” their services. But they aren’t forced to work for us. If every single one decided not to show up to work tomorrow, there is no mechanism by which the gov’t can require them to do so.

And I’m not talking about what our legislators have done, en masse, for decades, regardless of what the Constitution states. Read it. It doesn’t say anything about a whole host of programs that are in place. That doesn’t mean those programs should be there or are good for the country.

Okay, I’m not sure how their voluntary choice to take those jobs is relevant to this discussion. Doctors and nurses also are not enslaved people. Only cops and judges are paid for by taking money from me in the form of taxes. You’re actually arguing that existing government goons are legit because they are currently government goons.

The constitution gives the power to legislate to Congress. While it does place some limits, it does not say Congress has already finished its work and can’t make up new programs and tax people to pay for them. This is leaving aside what state and local governments can do.

Yes, we should simply debate the merits of a particular proposal rather than chase shiny objects like peculiar constitutional theories and political philosophies.

You brought it up, not me. You said, So stop looting me to pay for cops and courts to protect your property rights. Crybaby. which is an example progressives use whenever libertarians push back against gov’t-run programs.

And I said, stop conflating with socialism those few things that limited-gov’t advocates grudgingly accept, given the Constitution.

THAT’s how it’s relevant. These people willingly serve. They are protecting our rights to life, liberty, etc. Health care is not a right. It’s a cost of living. To make it a “right,” one has to socialize it. And socialism of any kind does not allow for willing service, for private, contractual arrangements between provider and client. Everything is gov’t mandated.

And it completely ignores the fact that most people want to help others. That doctors don’t just walk away and say, “Sorry, can’t treat you. Your ins won’t pay.” They work with patients to craft payment plans. They do pro bono work. Hell, low-income women in my city can get mammograms for free and we have a healthy non-profit that provides healthcare for the homeless to which many top docs in the city contribute their time and expertise.

And if we get gov’t and special interests out of health care entirely, prices will normalize to where most people will be able to afford care.

So many talking heads asserting they want to bust health care paradigms, but they don’t. Otherwise, they’d kick gov’t out of HC?as they should out of all private enterprise?and see what a truly free market system can do.

You people are talking crazy, you do realize? At some point you have to acknowledge literally all the evidence in the world. Every civilized country minus the US = national healthcare program, every one cheaper per capita in addition to providing some kind of universal access. The US simply chooses, by way of admitting a lot of private-sector interests, to fall short of universality while letting costs go double what other countries deal with. Why should we allow a vital and universally necessary service to be inefficient and costly for no reason? I’m really very sorry that it would disprove your weird little rugged individualist worldview, but so many things already do!

Have you actually researched these health care programs, Tony? Go ahead, I’ll give you some time. Then get back to me.

As for being inexpensive? Hah. I have friends and family all over Europe. To a person, they pay 50?70 percent in taxes for all these programs you laud.

Which is so weird, because if they got to actually KEEP all those tax dollars, they would be able to afford to pay for what they needed. And if you actually gave a shit about the poor and the indigent, you’d advocate for that. But, no. what you WANT is to steal from people all the while couching it in altruism so everyone else looks like a monster.

What was the last government program you can think of, that was actually repealed by Congress? It’s very difficult to get that teat out of people’s mouths even if there’s a more healthy source of sustenance. I’ve seen this personally with family members. All ambition is buried under ‘I’ll lose my (housing, healthcare, food stamps) benefits if I get a job.’ why strive for something you can just vote others to steal for you? The more stealers, the less strivers and there goes everyones standard of living.

All ambition is buried under ‘I’ll lose my (housing, healthcare, food stamps) benefits if I get a job.’

Well there you have it.

If we go to Medicare-For-All or something comparable, health insurance will no longer be tied to employment status, and as such employment changes will no longer carry a risk of losing insurance. This also works for folks that are afraid to change jobs, go self-employed, start a business and so-on.

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If they actually just wanted to make sure everybody has insurance, while still possibly getting okay outcomes for everybody else, it’s simple:

Deregulate ALL private health insurance like WHOA. This will kick in the market hardcore, and perhaps get some efficiencies going again.

Then you simply have a stupid income table, and pay for Medicare for poor ass people, and maybe some people in between give them the option to buy in. DONE.

They’d have to raise taxes and shit, but commies don’t mind doing that.

Something like this might actually not be a horrible tradeoff given how bad our current system is. If we stopped trying to regulate private insurance to gain maximum coverage, it could actually get better and cheaper for those that can afford it. The rest of the shit just put everybody on the hook for it.

The upshot here is that if the deregulation happened, it might get cheap enough that almost nobody would NEED the shit government care!

Which is probably why they would never do something like this… Because they’re dirty commie rat bags 🙁

Americans have been open to the concept, not the actual plan. Democrats never talk about the cost and the moment people realize for it to work, they will be paying tax rates of 60-80%, they reject it. There is no way to make such a plan work because the population of the US is simply too large. There are not enough people to tax to cover everyone. The system this plan would create would insure rationing of healthcare and would likely cause an actual revolution. Democrats have totally left the planet and any grasp on reality. The party is rocketing toward self destruction because it has been seized by radical leftist ideologues who do not care about compromise and believe they can actually win this fight. They want to destroy everything than attempt to find solutions that work because at their core they hate this country and everything it represents.

Until we go from a disease/sickness first based health system to a health first system, it won’t matter. Big Pharma will call the tune and the government (mainly us) will pay up the wazoo. Millions of unnecessary health procedures will be performed and millions more drug prescriptions will be written and the country will be no healthier…only broker. Just what we need with rising taxes on all fronts needed to pay for pensions and higher taxes needed to pay for runaway socialism.